Healthcare Provider Details

I. General information

NPI: 1669998845
Provider Name (Legal Business Name): THE LOS ANGELES FREE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

IV. Provider business mailing address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

V. Phone/Fax

Practice location:
  • Phone: 323-330-1651
  • Fax:
Mailing address:
  • Phone: 323-330-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MURIEL NOUWEZEM
Title or Position: CEO
Credential:
Phone: 323-337-1707